Provider Demographics
NPI:1144507773
Name:PERRELLO, ANN MARIE (RN)
Entity type:Individual
Prefix:MRS
First Name:ANN MARIE
Middle Name:
Last Name:PERRELLO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 OASIS LN
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14624-2214
Mailing Address - Country:US
Mailing Address - Phone:585-247-3372
Mailing Address - Fax:
Practice Address - Street 1:8 OASIS LN
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14624-2214
Practice Address - Country:US
Practice Address - Phone:585-247-3372
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-10
Last Update Date:2011-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY464646-1163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY163WS0200XMedicaid